Rights and Responsibilities as a Member of IEHP Medi-Cal
As an IEHP Member you have the following rights:
- To be treated with respect, giving due consideration to your right to privacy and the need to maintain confidentiality of your medical records.
- To be given information about the plan and its services, including Covered Services, practitioners, providers and member rights and responsibilities.
- To be able to choose a PCP within IEHP’s network.
- To take part in decisions about your health care, including the right to refuse treatment.
- To voice grievances, verbally or in writing, about the organization or the care given.
- To provide feedback about the organization’s member rights and responsibilities policies.
- To get care coordination.
- To request an appeal of decisions to deny, defer or limit services or benefits.
- To get oral interpretation services for their language.
- To get free legal help at your local legal aid office or other groups.
- To create advance directives.
- To have access to family planning services, Federally Qualified Health Centers, Indian Health Service Facilities, sexually transmitted disease services and Emergency Services outside IEHP’s network pursuant to federal law.
- To request a State Hearing, including instructions on how an expedited hearing is possible.
- To have access to and where legal and appropriate, get copies of, amend or correct your Medical Record.
- To disenroll upon request. members who can request expedited disenrollment include, but are not limited to, those getting services under the Foster Care or Adoption Assistance Programs and those with special health care needs.
- To access Minor Consent Services.
- To get written member-informing materials in other formats (such as braille, large-size print and audio) upon request and in a timely fashion appropriate for the format being requested and in accordance with Welfare & Institutions Code Section 14182 (b)(12).
- To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
- To learn about and discuss available treatment options and alternatives with regard to cost or benefit coverage, presented in a manner appropriate to your condition and ability to understand.
- To get a copy of your medical records and request amendments or corrections, as specified in 45 Code of Federal Regulations §164.524 and 164.526.
- To freely exercise these rights without adversely affecting how you are treated by IEHP, providers or the State.
- To have access to family planning services, Freestanding Birth Centers, Federally Qualified Health Centers, Indian Health Service Facilities, midwifery services, Rural Health Centers, sexually transmitted disease services and Emergency Services outside IEHP’s network pursuant to the federal law.
- If you have been getting care from a health care provider, you may have a right to keep him or her for a certain time period. Please contact IEHP Member Services and if you have more questions, please contact the Department of Managed Health Care, which protects HMO consumers, by telephone at its toll-free number, 1-888-466-2219 (TTY) 1-877-688-9891 or online at https://www.dmhc.ca.gov/.
As a Member of IEHP, you are responsible to:
- Be familiar with and ask questions about your health plan options, your health plan coverage limitations and exclusions, rules about the use of network providers, coverage and exclusions, rules, appropriate process to obtain information and process to appeal coverage decisions. If you have a question about your coverage, call IEHP member Services at 1-800-440-IEHP (4347), Monday-Friday, 7 a.m.-7 p.m. and Saturday-Sunday, 8 a.m.-5 p.m. TTY users should call 1-800-718-IEHP (4347).
- Follow the advice and care procedures requested by your doctor and IEHP. If you have a question about these procedures, call IEHP member Services at 1-800-440-IEHP (4347), Monday-Friday, 7 a.m.-7 p.m. and Saturday-Sunday, 8 a.m.-5 p.m. TTY users should call 1-800-718-IEHP (4347).
- Request interpreter services at least 5 working days before a scheduled appointment.
- Call your doctor or pharmacy at least 3 days before you run out of medicine.
- Cooperate with your doctor and staff and treat them and other patients with respect. This includes being on time for your visits or calling your doctor if you need to cancel or set up a new appointment.
- Understand that your doctor’s office may have limited seating for patients and caregivers only.
- Give accurate data to IEHP, your doctor and any other provider. This helps you get better care.
- Understand your health care needs and be part of your health care decisions. Ask your doctor questions if you do not understand.
- Work with your doctor to make plans for your health care.
- Follow the plans and instructions for care that you have agreed on with your doctor.
- Notify IEHP and your doctor if you want to stop the plans and instructions you have agreed on or no longer want to participate in health management programs.
- Immunize your children by age 2 years and always keep your children’s vaccines up to date.
- Call your doctor when you need routine or urgent health care.
- Care for your own health. Live an active life, exercise, have a good diet and don’t smoke.
- Avoid knowingly spreading disease to others.
- Use IEHP’s grievance process to file a complaint. Call IEHP member services at 1-800-440-IEHP (4347), Monday-Friday, 7 a.m.-7 p.m. and Saturday-Sunday, 8 a.m.-5 p.m. TTY users should call 1-800-718-IEHP (4347) to file a complaint (grievance or appeal).
- Report any fraud, waste or abuse to IEHP by calling the Compliance Hotline at 1-866-355-9038 or the proper authorities.
- Understand that there are risks in getting health care and limits to what can be done for you medically.
- Understand that it is a health care provider’s duty to be efficient and fair in caring for you as well as other patients.